Anti-vaccine legislation puts health care organizations in an impossible situation – commentary
“Reflecting on the incredible history of inoculation and vaccine efforts in America is imperative when weighing variables and making vaccine policy decisions that affect both our personal and public health.” (Mario Tama | Getty Images)
As the chief executive officers of New Hampshire’s community health centers that serve 112,000 Granite Staters, we write today out of grave concern for the future of public health in New Hampshire. What began as an effort to eliminate COVID-19 vaccine requirements has transformed into a movement at the state Legislature to kick the legs out from under New Hampshire’s long-standing childhood and adult vaccine program.
The state Legislature, as we speak, is considering dozens of bills that, if they became law, would take away the ability of our schools, colleges, universities, private businesses, day care centers, and health care organizations to require vaccines against communicable diseases like hepatitis, influenza, measles, meningitis, and polio, as well as COVID-19.
One common tactic being used is creating ubiquitous, nonmedical vaccine mandate exceptions called “conscientious objection” and “matter of conscience” that would essentially render all vaccine requirements meaningless. Another strategy is to try to make immunization status a “protected class,” regardless of the reason a person chooses not to be vaccinated, thereby deeming it discrimination for a business not to employ someone because they are not vaccinated against an infectious disease.
New Hampshire’s community health centers serve one in four Granite Staters who are uninsured and one in four Granite Staters enrolled in Medicaid, and we – along with hospitals, nursing homes, and all health care organizations that serve Medicare and Medicaid patients – are required by federal law to have COVID-19 vaccination requirements in place for our staff, board members, and students in training. If the anti-vaccine bills currently under consideration became state law and removed our health centers’ ability to mandate COVID-19 and other vaccines, we would be between a rock and a hard place: We would be in violation of state law if we mandated vaccines, and in violation of federal law if we didn’t.
The more terrifying risk these bills carry is bringing back highly infectious and deadly diseases that previous generations have eliminated or nearly eliminated through public health measures framed in the early days of our nation. Benjamin Franklin, whose son died of smallpox, was one of the leading proponents of inoculation, “the precursor to vaccination,” having observed its first uses.
At the end of the 20th century, the Centers for Disease Control and Prevention published a report on the historical achievements of record-high levels of childhood vaccine uptake – reducing diseases to nearly zero that were a scourge in the United States throughout its history: Smallpox was eradicated in 1977; polio incidence sharply declined, from over 16,000 cases a year in 1954 to fewer than 100 cases in 1963; and measles prevalence diminished, from over 500,000 cases a year in 1962 to 89 cases by 1998, with no measles-associated deaths.
Though Americans continue to benefit from the non-existence of many of these vaccine-preventable diseases in our health and everyday lives, we must not forget that they still persist in parts of the world where vaccine is not readily available.
Reflecting on the incredible history of inoculation and vaccine efforts in America is imperative when weighing variables and making vaccine policy decisions that affect both our personal and public health. Imagine the dangers of sending your child back to school or child care where their classmates are not vaccinated for measles, mumps, and rubella, or to a college or university that doesn’t require a meningococcal vaccine. These are the frightening new realities these bills would create if passed in the New Hampshire Legislature. The risk to school-aged children is both unacceptable and unprecedented.
Community health centers are preventive care and primary care providers first and foremost. Our staff are by nature of the job in daily contact with individuals who are carrying respiratory illnesses, and our main concern understandably is keeping them and our patients safe. Even before the federal Centers for Medicare and Medicaid Services requirements for providers who accept Medicare and Medicaid went into effect, community health centers implemented COVID-19 vaccine requirements for our staff, who have been extremely compliant – just as they were with traditional vaccine and testing requirements for other contagious diseases like hepatitis and influenza. We all know that vaccine requirements for certain diseases are not new to students or health care professionals, yet they are under attack now, during a pandemic, when we need them most.
In New Hampshire, 23 health care workers have died from COVID-19. The impact of that number has significant meaning from our perspective as community providers. Every employee is invaluable, and it is incredibly difficult to replace, recruit, and retain health care workers in our rural state, let alone at nonprofit health care organizations such as ours. The families of the 23 health care workers who died must live with this loss throughout their lives, and the impact is felt by their colleagues and community members as well. This is our reality, and we respectfully ask our elected officials to prioritize the health and best interest of their constituents and allow Granite State schools, businesses, and health care providers to do the same.
(This commentary is also signed by Anna Thomas, executive director, Health Care for the Homeless; Edward D. Shanshala II, executive director/CEO, Ammonoosuc Community Health Services, Inc.; Greg White, CEO, Lamprey Health Care; Ken Gordon, CEO, Coos County Family Health Services; Kris McCracken, president/CEO, Amoskeag Health; Michael Lee, president/CEO, Weeks Medical Center; and Russell G. Keene, CEO, HealthFirst Family Care Center)
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